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Provider: Derbyshire Healthcare NHS Foundation Trust Requires improvement

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Reports


Inspection carried out on 22 May 2018

During an inspection to make sure that the improvements required had been made

Our rating of the trust stayed the same. We rated it as requires improvement because:

  • We rated  safe, effective, responsive and well-led  overall as requires improvement and caring as good.This includes the previous ratings of three services that we did not inspect on this occasion. We rated four of the trust's 10 core services as good and four as requires improvement, one as inadequate and one as outstanding.

  • Although the trust leadership team had a comprehensive knowledge of current priorities and challenges and acted to address them, the pace of change was slow, which we highlighted in previous inspection. This meant that we did not see enough improvement in clinical services, and a deterioration in the acute admission wards. We found a lack of leadership in some core services such as the acute admission wards and crisis service.

  • The quality committee did not have robust oversight and assurances of drug and therapeutics and medicines management in the trust. There were no clear measures for performance management of the pharmacy service or evaluation of the impact of staff shortages.

  • Staff in four clinical settings did not check the fridge temperatures for stored medication regularly. This meant that there was a risk that medicines would deteriorate and be unfit to use. We flagged up this problem at our last inspection.

  • Four core services did not have enough staff. For example there was a shortage of, speech and language therapists, psychologists. This meant that longer waiting times occurred for dysphagia assessments and psychologist assessments. There was also a shortage of nurses and psychiatrists. Besides  the care coordinators ,we found this in the previous inspection.

  • There was a lack of trained staff for the health based place of safety. Staff mandatory training, supervision and appraisals still did not meet the trust targets.

  • We found there were small groups of staff who did not feel valued and involved in strategic decision making, for example, allied health professionals and psychologists. We found this in our previous inspection.

  • Not all staff had heard of the Speak Up Guardian role. There was a perceived conflict of interest between the post holder carrying out the Speak Up Guardian role and being a human resources manager at the same time.

  • Staff in three clinical services did not check emergency bags regularly in accordance with trust policy, to make sure they were ready to use.

  • Staff in three clinical services had not completed incident forms when making safeguarding referrals in accordance with trust policy. This meant they would not have accurate data.

  • Some staff did not implement the smoking policy as they did not wholly agree with the non smoking policy directives, this meant smoking occurred within buildings and within hospital grounds posing a fire risk.

  • The quality of care plans, physical health assessments and physical health care plans undertaken by staff was still not consistent across clinical services. This meant staff would not have all the information required about a patient to provide care.

  • We continued to find that not all patients were involved in their care plans or given copies of their care plans. Not all patients had crisis plans in place. There was variability in the use of advance decisions across core services. Patients make advance decisions to indicate their preferred treatment in particular situations.

  • The ward environments did not support safe care. Acute admission wards had blind spots along their bedroom corridors and lacked parabolic mirrors, and staff were not always present in these areas.  The cleaning trolleys used on the wards at Hartington Unit held hazardous cleaning materials but had broken doors that did not lock. The health based place of safety had ligature points ( these are places were a ligature could be tied to self harm).

  • Slow IT systems impacted on the quality of care, for example staff found the log in and log out process for recording 15-minute observations hindered the recording of real time observations.
  • The trust did not have up to date service level agreements with one local acute trust to support Mental Health Act functions and psychiatric liaison services.

However:

  • The trust board had the range of skills, knowledge and experience to perform its role. Significant improvement had occurred in the stability of the trust board and board development since our earlier inspection. The trust chief executive continued to give good systemic leadership in the Sustainable Transformation Partnership and the mental health workstream.

  • There was improvement in the extent most staff felt respected, supported, and valued in the trust since our previous inspection. The trust recognised staffing challenges and had a robust recruitment strategy using a range of initiatives.

  • Since our previous inspection the trust had made improvements in the human resources department, in relationships with trade unions and in its approach to equality and diversity.

  • Since the previous inspection the trust had improved its governance structures to support the delivery of its strategy. Non-executive and executive directors were now clear about their areas of responsibility.

  • There was improvement in the relationship between the trust board and council of governors'. Improvements in the composition, accountability, functioning and training of the governors’ council had occurred since our previous inspection. The governors held the non executives to account.

  • The wards and clinical bases that we visited were clean.

  • There were good systems in place to support staff, patients, and carers when serious incidents occurred.

  • There was good management of complaints and there was an increase in compliments.

  • Patients had safety plans and recovery hubs provided patients with a range of activities. Care and treatment followed the National Institute Health and Care Excellence (NICE) guidance. Information was available to patients on a range of issues. .

  • Patients and carers said staff were compassionate, caring and kind. Staff listened and treated patients with dignity and respect.  Staff knew their patients and patents gave positive feedback on the quality of care.
  • Staff had good knowledge of the Mental Health Act. Improvements had occurred in relation to the Mental Capacity Act and recording of capacity and consent.

  • Good multi agency working occurred and staff said there was good team working. This resulted in good discharge planning.


CQC inspections of services

Service reports published 4 June 2019
Inspection carried out on 18 - 20 March 2019 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 454.72 KB (opens in a new tab)
Service reports published 24 January 2019
Inspection carried out on 3rd December 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 297.29 KB (opens in a new tab)
Service reports published 28 September 2018
Inspection carried out on 22 May 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 505.46 KB (opens in a new tab)Download report PDF | 1.7 MB (opens in a new tab)Download report PDF | 3.13 MB (opens in a new tab)
Inspection carried out on 22 May 2018 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 505.46 KB (opens in a new tab)Download report PDF | 1.7 MB (opens in a new tab)Download report PDF | 3.13 MB (opens in a new tab)
Inspection carried out on 22 May 2018 During an inspection of Wards for older people with mental health problems Download report PDF | 505.46 KB (opens in a new tab)Download report PDF | 1.7 MB (opens in a new tab)Download report PDF | 3.13 MB (opens in a new tab)
Inspection carried out on 22 May 2018 During an inspection of Community-based mental health services for older people Download report PDF | 505.46 KB (opens in a new tab)Download report PDF | 1.7 MB (opens in a new tab)Download report PDF | 3.13 MB (opens in a new tab)
Inspection carried out on 22 May 2018 During an inspection of Community-based mental health services for adults of working age Download report PDF | 505.46 KB (opens in a new tab)Download report PDF | 1.7 MB (opens in a new tab)Download report PDF | 3.13 MB (opens in a new tab)
Inspection carried out on 22 May 2018 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 505.46 KB (opens in a new tab)Download report PDF | 1.7 MB (opens in a new tab)Download report PDF | 3.13 MB (opens in a new tab)
See more service reports published 28 September 2018
Service reports published 23 May 2018
Inspection carried out on 13 March 2018 During an inspection of Wards for older people with mental health problems Download report PDF | 263.68 KB (opens in a new tab)
Service reports published 18 April 2017
Inspection carried out on 13 February 2017 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 211.17 KB (opens in a new tab)
Service reports published 4 April 2017
Inspection carried out on 19/01/2017 During an inspection of Community health services for children, young people and families Download report PDF | 262.41 KB (opens in a new tab)
Service reports published 29 March 2017
Inspection carried out on 14 December 2016 During an inspection of Forensic inpatient or secure wards Download report PDF | 352.56 KB (opens in a new tab)
Inspection carried out on 12 January 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 323.24 KB (opens in a new tab)
Service reports published 29 September 2016
Inspection carried out on 6 -10 June 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 334.05 KB (opens in a new tab)Download report PDF | 583.16 KB (opens in a new tab)
Inspection carried out on 6- 10 June 2016 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 327.31 KB (opens in a new tab)Download report PDF | 583.16 KB (opens in a new tab)
Inspection carried out on 6 June – 10 June 2016 During an inspection of Community-based mental health services for older people Download report PDF | 306.37 KB (opens in a new tab)Download report PDF | 583.16 KB (opens in a new tab)
Inspection carried out on 6 June -10 June 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF | 336.13 KB (opens in a new tab)Download report PDF | 583.16 KB (opens in a new tab)
Inspection carried out on 6 – 10 June 2016 During an inspection of Forensic inpatient or secure wards Download report PDF | 372.36 KB (opens in a new tab)Download report PDF | 583.16 KB (opens in a new tab)
Inspection carried out on 6 June – 10 June 2016 During an inspection of Community health services for children, young people and families Download report PDF | 351 KB (opens in a new tab)Download report PDF | 583.16 KB (opens in a new tab)
Inspection carried out on 6 to 10 Jun 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 370.92 KB (opens in a new tab)Download report PDF | 583.16 KB (opens in a new tab)
Inspection carried out on 6-10 June 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 405.15 KB (opens in a new tab)Download report PDF | 583.16 KB (opens in a new tab)
Inspection carried out on 6 – 10 June 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 300.49 KB (opens in a new tab)Download report PDF | 583.16 KB (opens in a new tab)
Inspection carried out on 6-10 June 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 322.43 KB (opens in a new tab)Download report PDF | 583.16 KB (opens in a new tab)
See more service reports published 29 September 2016
Inspection carried out on 6-10 June 2016

During a routine inspection

We have rated Derbyshire Healthcare NHS Foundation Trust as requires improvement overall because:

  • The trust lacked robust leadership. This had resulted in variation in the quality and safety of services provided. The CQC had undertaken a joint inspection of the trust with Deloitte in January 2016. This criticised the quality of leadership. Although some improvements had been made since that joint inspection, the pace of change and ability of the senior leadership to grasp the seriousness of the deficits has not been quick enough. As a group, the executive team lacked the full depth and breadth of skills required to enable the improvements needed in culture, governance and HR throughout the trust.
  • Trust assurance and reporting systems had failed to recognise serious safeguarding issues that had occurred on the wards for older people with mental health problems since 2011. Although senior staff were aware of the issues, no decisive action had been taken to effectively safeguard and protect patients from potential abuse.

  • Some front-line staff lacked confidence in the leadership team and felt detached from the central management functions. Although the trust leadership team has started work to improve engagement with staff, there is still much to be done in this area.

  • The quality of clinical services varied. We have rated the forensic wards and wards for older people with mental health problems as inadequate. This was mainly due to the safety of the environments, concerns about safeguarding and a lack of staff understanding on how to interpret and apply the Mental Health Act and the Mental Capacity Act. In a number of core services, staff were not recording risk assessments, best interest decisions or care plans well.

However:

  • We found the staff to be consistently caring and they treated patients with kindness, dignity and respect. The feedback received from both patients and carers regarding the quality of care was positive and demonstrated a staff group who have the patients’ best interests continually in mind.

Following our inspection, CQC has issued the trust with a Section 29a warning notice.

NHS Improvement launched an investigation into Derbyshire Healthcare NHS Foundation Trust in 2015, in respect of governance concerns identified from the judgement of an Employment Tribunal, and concerns raised by other third parties. In February 2016, based on evidence from independent reviews commissioned by the Trust, a focussed inspection by the Care Quality Commission and an independent review of governance arrangements, NHS Improvement formally found the Trust to be in breach of its licence. The Trust has agreed a number of enforcement undertakings with NHS Improvement which it is required to implement, and has developed an action plan to secure delivery of the enforcement actions and return to compliance with its licence.

The CQC and NHS Improvement meet with the trust leadership on a monthly basis; we will be continuing this approach to agree an action plan to assist them in improving the standards of care and treatment. 

Inspection carried out on 6 – 8 & 12 January 2016

During an inspection to make sure that the improvements required had been made

In July 2015, Monitor opened an investigation into the Trust, due to governance concerns identified from the judgement of an Employment Tribunal. Monitor also has concerns following related complaints raised by other parties including individuals who have approached Monitor in line with its whistleblowing policy. The Trust is currently undertaking two pieces of work to respond to the issues raised by the judgement and by the Monitor investigation:

  • An independent investigation into the findings of the judgement, both as they relate to the performance and conduct of individuals and to wider issues of standards of corporate governance.
  • An independent investigation into individual complaints raised by current or ex-members of staff about the behaviour of current or ex-members of staff.

The Trust appointed an external agency to carry out a focused review of specific elements of its governance arrangements. Monitor, the Care Quality Commission (CQC) and Deloitte looked into the leadership and governance arrangements and into the performance of the HR and related functions at the Trust. Each body will report separately. This report describes the findings of the CQC focused inspection.

This focused inspection looked specifically at the following:-

  • Vision, values & strategy
  • Are recruitment and performance management processes objective and transparent?
  • Are there clear roles and accountabilities in relation to board governance (including quality governance)?
  • Does the board actively and effectively engage patients, staff, governors and other key stakeholders on quality, operational and financial performance?

We would like to thank the trust and its staff for their help and co-operation throughout the review.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.